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Carrier Relations Committee Kemp Skokos, MD, Chair Samuel Welch, MD Carl Raque, MD Ann Layton, MD Dale Blaiser, MD Dwight Phillips, Administrator, Baptist Health Family Clinic Dan Caldwell, Administrator, Little Rock Cardiology Clinic Carrier Relations Committee Overview H.E.L.P. Log Form CRC Meetings The CRC holds monthly meetings designed to build ongoing relationships with insurance companies. Physicians interested in serving on the Carrier Relations Committee and participating in future projects are urged to contact PCMS at 687-0039. CRC Update (CRC Data Summary - 2005) Carrier Relations Committee Summary Serve as community and physician advocate, Improve relationships between physicians and insurance companies, and Restore sovereignty of the patient-physician relationship The PCMS Carrier Relations Committee was organized about five years ago under the leadership of Sam Welch, MD. Complaints about third party payers were increasing. Frustrated physicians and clinic staff were, in many cases, without a voice in efforts to communicate effectively with insurance carriers. Clearly physicians had a right to be heard - to have a fair and equitable voice in a myriad of confusing issues impacting on patient care, staff time, and reimbursement. Finding a way through an ever-changing maze of menus and customer service representatives at insurance companies was particularly frustrating for staff of smaller clinics. Larger clinics, with more advanced IT, had different concerns. The committee wanted to find a way to improve communication between physicians and health care payer groups, encourage fair and prompt payment for physician services and to facilitate adequate access to health care for patients. Developing a process for collecting and analyzing hassles with insurance companies became one of the first objectives. Hassle factor logs were collected from other medical societies and a site visit was made to the Texas Medical Association to assess their hassle elimination program. The Arkansas Medical Society was included in the initial planning process. It was expected that if Pulaski County’s efforts were successful, the program could be expanded statewide. The committee developed a Hassle Elimination Liaison Program (H.E.L.P.) and designed a H.E.L.P. log for collecting complaints on a range of topics. Clinic managers throughout the county were invited to attend a series of luncheons introducing the H.E.L.P. program and encouraged to participate by completing and returning H.E.L.P logs. The form allowed office managers to identify the problem(s) and check off frequency of occurrences. As the data starting pouring in, the committee determined that, rather than looking at individual complaints requiring volumes of documentation, they would review trending data and address broad trends in efforts to resolve the administrative hassles and complaints physicians were encountering with insurance carriers. Initially, excessive telephone hold time far exceeded other complaints. Clinic managers were also reporting that by the time a representative answered he/she often did not know the answer. Supplemental Telephone Logs were distributed. A focused review was conducted confirming the initial trend findings. John Hartnedy, Deputy Director, Arkansas Insurance Department, met with the committee in early 2003 and expressed support for the committee’s commitment to ensure a positive process. Opinion Research Associates, Inc. was engaged to analyze data and to prepare and present reports for use in meetings with insurance carriers and reporting to physicians and clinic managers. Letters were sent to the insurance carriers informing them of the results. The committee met with the leadership of BCBS, Health Advantage, QualChoice & United Healthcare. Positive and negative results were published in PCMS News. Follow-up meetings were scheduled with clinics to report the outcomes and distribute information on the next survey. In June 2003, economist, Jim Metzger, Ph.D., president of Histecon, Inc., was engaged to track the data and provide a scientific standard for collecting and reporting data. Representatives of the major carriers met with clinic managers at different locations throughout the county in 2004. They answered questions and provided clinic staff with a variety of contact information. All the insurance companies promoted on-line claims filing. Many, it appeared, offered ways to track claims through their system. By the end of 2004 it was clear that clinics without electronic contact with carriers were encountering difference problems than those with IT systems. The committee needed to know how many clinics were using some type of electronic contact with carriers in order to analyze data properly. A February 2005 mail-out survey culminated with a total of 95 responses and the following results: · Most (82 percent) use on-line contacts with carriers. · Many (18 percent) either do not file or do not use the on-line connections with carriers. Of the 78 clinics that use some type of electronic contact with carriers: · 42 percent use on-line contacts infrequently (1 out of 4 contacts, or less) · 35 percent use on-line contacts frequently (about 1 out of 2 contacts); and · 23 percent use on-line contacts very frequently or exclusively (about 3 out of 4 contacts, or more); these are the most favorable about on-line benefits. In the summer of 2005, the CRC began talks with physician volunteers from outside Pulaski County. Purpose of the discussion is to determine interest in a statewide affiliation. (UPDATE 2006) The Hassle Elimination Liaison Program (H.E.L.P.) continued to identify issues such as concerns about excessive telephone hold times, denial of payment, denial of claims, and claims denied in error. Because these complaints were prevalent in the logs during past studies, the pocketbooks issues such as payment and claim denials were pursued in more detail by the Committee in a different study last year. The H.E.L.P. logs pointed to some stubborn problems that clinics and hospitals have communicated before, including excessive telephone hold times, denial of payment and denial of referral, and excessive paperwork review or lost documents. In addition, for the hospital-based clinics the problems remain with lost “Med Facts” requests, primarily with one insurance carrier, which only sends these requests by fax to one number per doctor, even if the doctor practices and sees patients in many locations. However, according to clinic officials, meetings with the carrier appear to have resolved this long-standing issue with credit to the Carrier Relations Committee given by the clinic administrator. More than 80 clinics responded to a 2005 survey regarding on-line claims processing. The data was analyzed and reported to the CRC, followed by a report to the Board and newsletter article. Dr. Sam Welch presented a proposal to the Arkansas Medical Society in February 2005 for an AMS ad hoc committee to explore involving doctors around the state. The AMS provided names of physicians who agreed to serve on the committee including: Drs. Michael Saitta of Fayetteville; Eugene Shelby of Hot Springs and Robert Sanders of Fort Smith. A February 2005 mail survey of all Pulaski County clinic managers resulted in a return of 95 responses. Purpose of the survey was to determine how many clinics were filing claims electronically: - Most (82 percent) use on-line contacts with carriers. - Many (18 percent) either do not file or do not use the on-line connections with carriers. Of the 78 clinics that use some type of electronic contact with carriers: - 42 percent use on-line contacts infrequently (1 out of 4 contacts, or less) - 35 percent use on-line contacts frequently (about 1 out of 2 contacts); and - 23 percent use on-line contacts very frequently or exclusively (about 3 out of 4 contacts, or more); these are the most favorable about on-line benefits. The CRC is moving forward toward statewide expansion of CRC activities. Updated Version of H.E.L.P. Logs can be downloaded from the Society's website at H.E.L.P. Log Form. |
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